title: Coronary artery calcification predicts long-term mortality in hypertensive adults.
abstract: BACKGROUND
  Coronary artery calcification (CAC) predicts mortality in normotensive individuals. We hypothesized that CAC has an impact on long-term mortality in hypertensive patients.
  
  
  METHODS
  We followed 423 participants of the INSIGHT (International Nifedipine Study Intervention as Goal for Hypertension Therapy) calcification substudy, for the incidence of mortality as a function of CAC. All patients were hypertensive (mean age 64 ± 6 years, 48% male), without coronary artery or peripheral vascular disease, aged >55 years and with at least one more major cardiovascular (CV) risk factor. All underwent a baseline computed tomography (CT) (Dual slice) to determine the calcification score and were followed for a mean period of 14 ± 0.5 years. Mortality and the cause of death were derived from the registry of the Ministry-of-Interior Affairs.
  
  
  RESULTS
  During the follow-up, 94 patients died; 27 from CV causes, 54 from non-CV causes and 13 of undefined causes. The prevalence of calcification at baseline was 59% (195/329) among the survivors compared to 82% (77/94) in participants who died and 96.7% (26/27) among those who died of CV causes. The incidence of CV death was 14 times higher among those with than those without CAC (9.6% (26/272) vs. 0.7% (1/151); P < 0.01). After adjusting for age, gender, left ventricular hypertrophy, proteinuria, duration of hypertension, and renal function the presence of calcification predicted all cause mortality with a hazard ratio (HR) of 1.8 (95% confidence interval (CI) 1.04-3.07).
  
  
  CONCLUSIONS
  CAC is associated with long-term mortality in asymptomatic hypertensive adults.
authors.affiliation: Grace Ballas Research Unit of the Cardiac Rehabilitation Institute, The Chaim Sheba Medical Center, Tel-Hashomer, Israel. joseph.shemesh@sheba.health.gov.il
authors.forename: Joseph
authors.initials: J
authors.lastname: Shemesh
authors.forename: Michael
authors.initials: M
authors.lastname: Motro
authors.forename: Nira
authors.initials: N
authors.lastname: Morag-Koren
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
authors.forename: Sara
authors.initials: S
authors.lastname: Apter
authors.forename: Avraham
authors.initials: A
authors.lastname: Weiss
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002114:Calcinosis / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors